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STATES OF JERSEY
r
SCRUTINY REVIEW OF THE
GOVERNMENT PLAN: 2020–2023
(S.R.13/2019) – JOINT RESPONSE OF
THE MINISTERS FOR HEALTH AND
SOCIAL SERVICES AND
SOCIAL SECURITY
Presented to the States on 30th December 2019
by the Minister for Health and Social Services
STATES GREFFE
2019 S.R.13 Res.
SCRUTINY REVIEW OF THE GOVERNMENT PLAN: 2020–2023
(S.R.13/2019) –JOINT RESPONSE OF THE MINISTERS FOR HEALTH AND
SOCIAL SERVICES AND SOCIAL SECURITY
Ministerial Response to: S.R.13/2019
Review title: Scrutiny Review of the Government Plan:
2020–2023
Scrutiny Panel: Government Plan Review Panel
INTRODUCTION
Minister for Health and Social Services:
The Minister for Health and Social Services expresses his thanks to the Panel for its
work on analysing the Government Plan.
Minister for Social Security:
The Minister for Social Security is grateful to the Panel for the work that has been
undertaken during this review.
FINDINGS
Findings Minister Comments
1 The total Heads of Expenditure for the MHSS Agreed, but excluding the impact of
Health and Community Services efficiencies, pay award and other
Department is £211 million. In respect transfers.
of Ministerial allocations, the Minister
for the Health and Social Services
receives the highest allocation of
funding (£211 million) for his remit
out of all the Council of Ministers.
2 Unlike the Medium-Term Financial MHSS & The HCS budget is presented in the
Plans, where the information was MSS agreed corporate style for the
provided in an annex, the Government Government Plan as for all other
Plan lacked any details regarding the Departments.
breakdown of departmental budgets.
3 The Efficiency Plan 2020 states that MHSS Agreed
£1.77 million worth of efficiencies will
be made through ‘commercial
operations’ and £3.67 million through
‘operational excellence’. It also
indicates that £750,000 worth of cross-
cutting operations are attributed to the
Health and Community Services
Department.
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Findings Minister Comments
4 The Health and Community Services MHSS The £2.8 million forms part of the total
Department is due to make £9 million Modern Workforce efficiencies total.
worth of efficiencies in 2020.
However, only £6.1 million worth of
efficiencies in respect of HCS are
described within the Efficiencies Plan
2020-23. It is unclear to the Panel how
the remaining £2.8 million worth of
efficiencies will be achieved.
5 The Panel has been advised by the MHSS The department will be drafting a
Minister for Health and Social Workforce Strategy and Plan. As part
Services that there will be no of the Strategy, the department needs to
headcount reductions as result of undertake a skills analysis as well as
Health and Community Services’ reviewing roles to enable delivery of
efficiency programme. However, the the Jersey Care Model. The department
Panel still has concerns that requires an agile and flexible workforce
efficiencies may result from not that is fit-for-purpose and for the future.
replacing current vacant posts within There are no plans to reduce headcount.
the hospital.
6 The action “Develop a Health and MHSS Yes
Wellbeing Framework” will be
delivered within existing departmental
budgets.
7 The action “provide appropriate MHSS Yes. People with learning disability
accommodation for people within access Long-Term Care and other
Learning Disability Services” is not revenue funding as do other Jersey
linked to a project seeking additional citizens.
revenue expenditure because it is
instead linked to a capital project.
8 A Health and Wellbeing Policy MHSS Yes. The Health and Wellbeing
Framework is currently being drafted Framework is currently being drafted. It
which will link and coordinate actions is due to be completed and published by
across Government to support the end of Q1 2020.
islanders to live healthier and fuller
lives, including those developed under
the “preventable diseases” project. The
Panel was advised that the intention
was for the Framework to be
completed by the end of 2019.
9 The £300,000 funding requested for MHSS Yes
2020 under the “preventable diseases”
project would be spent on health
promotion and introducing a two-year
pilot scheme to provide healthy meals
in primary schools.
10 The £102,000 funding requested for CM Correct. The need for additional
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Findings Minister Comments
the Adult Safeguarding Improvement resources is supported by a business
Plan in 2020 would provide funding case, with the work programme based
for two additional FTEs who are on the recommendations from
needed to co-produce and implement independent reviews in 2018.
the Plan.
11 The project “Mental Health” includes a MHSS Yes, the £3.2 million is correct.
number of ambitious programmes and
workstreams over the next 4 years. To
ensure their delivery, the Government
Plan has requested £3.2 million
additional investment in 2020.
12 At the start of 2019, £22.5 million was MHSS Yes
already invested in services which are
delivering mental health activity.
13 The Medical Director of Mental Health MHSS Yes, this has been partially completed.
is due to undertake a review of Jersey
Talking Therapies to determine the
reasons for the current long waiting
lists and to understand how resources
could be moved around to deliver the
service differently. It was confirmed
that funds are within the Government
Plan to undertake this work.
14 The listening lounge will initially be a MHSS Yes. The Listening Lounge opened in
2-year pilot project and the requested November 2019.
funds within the Government Plan
(£0.3 million in 2020) are required to
support its implementation, to appoint
a project team and to staff the facility.
15 The Adult Mental Health Service is MHSS Yes, this is a national challenge.
currently under significant strain Ongoing recruitment exchange to seek
because of staff shortages. to address the issue. MH management
team now fully appointed and staff in
situ.
16 The level of resources requested for MHSS Yes
mental health should be sufficient to
enable the project to meet its stated
aims. However, the sustainability and
successful implementation of the
programme is dependent on successful
recruitment and retention of a high-
quality workforce and improved
collaboration with third and private
sector partners.
17 There is a lack of clarity within the MHSS Internally, HCS has appointed a Chief
Government Plan as to how the Digital Clinical Information Officer (CCIO) to
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Findings Minister Comments
Health and Care Strategy will be clinically lead on the digital agenda.
delivered. The portfolio sits under the Executive
Director for Health Modernisation who
commenced in post in November. The
team has established a digital board to
determine the strategy and rationalise
the financial ask. A strategy document
is being developed. There is
collaborative work with the
Modernisation and Digital team within
the Chief Operating Office.
18 Within the Government Plan there is MHSS Funding will be discussed with the
no clear line of funding for the Chief Operating Officer Department.
development of a digital patient
records system, which it has been
estimated will cost in the region of
£30 million.
19 It is the intention of the Health and MHSS HCS aspires to be fully digital in
Community Services Department to be 2 years and to have an EPR (electronic
digital in 2 years and to have the patient record) in place when our
electronic patient records system in current contract with ‘intersystems’
place in 3 years. expires in 2022.
20 The Government Plan is seeking MHSS Yes
£3.6 million to be restored to the
Health and Community Services
Health baseline budget to fund the
delivery of a new Health Care Model,
in line with the principles of P.82/2012
– ‘A new way forward for Health and
Social Care’.
21 Additional funds of £4.1 million have MHSS Yes
been requested for 2020 under the
“Maintaining Health and Community
Standards” project to ensure that health
and social care standards are
maintained at a level comparable with
the UK and other European
jurisdictions.
22 To assist the Government budget MHSS Yes. As part of the Government budget
setting for 2020, the “maintaining setting process, it was agreed that HCS
community health and care standards” would receive £1 million less than
project will receive £1 million less in originally sought and that this would be
2020 and manage any consequential replaced in 2021.
pressures in year with the funds being
remunerated in 2021.
23 A full business case was not produced CM As the expression of interest published
for the “Regulation of Care” project as says, the £200,000 built into the MTFP
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Findings Minister Comments
the additional investment requested in (2017-19) from 2018 for user pays
2020-2023 is intended to fund a income under the Regulation of Care
shortfall from the non-receipt of Law did not allow for the increased
income that was budgeted to be costs of regulation. As such, this
received through the regulation of care change in the Government Plan is
legislation in 2018. straightforward. A full business case
was unnecessary.
24 The “Mental Health Improvements” MHSS Yes
capital project requests £3,930,000 in
additional funding for; investment in
works to “make safe” Orchard House
and to prepare Clinique Pinel and
Rosewood House to allow the delivery
of high quality and safe mental health
care.
25 Whilst the Panel is satisfied that the MHSS Yes, but continuous attention is paid to
amount of additional funds requested maintaining the timetable, working
is adequate to undertake the necessary collaboratively with colleagues in
work on mental health facilities, it has Jersey Property Holdings. The project
concerns regarding the timeframe for is a standing agenda item on the weekly
the completion of Clinique Pinel and, executive meeting.
specifically, the provision of a place of
safety.
26 The Minister for Health and Social MHSS Yes. Options have been explored and a
Services has expressed his own new place of safety suite will be part of
frustration about the progress that had the refurbishment at Clinique Pinel and,
been made in delivering a place of eventually, the new hospital.
safety.
27 The project “Health Service MHSS There is significant backlog
Improvements” seeks to deliver, not maintenance and significant investment
only essential maintenance work to the in digital required. This will remain
current hospital, but also initial work under review.
for the development of digital patient
records. The Panel is concerned that
the funding identified for 2020-2023
(£5 million per annum) is insufficient
to deliver these priorities.
28 Immediate works to Aviemore, to MHSS Yes
ensure the building is legally
compliant, will be funded under
Capital Project “Discrimination Law,
Safeguarding and Regulation of Care,
in which £2 million has been allocated
to HCS for the years 2020-23.
29 The Health and Community Services MHSS Yes, alternative accommodation has
Department is currently working with been sourced for 2 of the residents,
a number of provider organisations to enabling a safer environment for the
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S.R.13/2019 Res.
Findings Minister Comments
seek alternative accommodation for the remaining 2. We are seeking permanent
Aviemore residents. accommodation for them, while
continuing to engage with partners.
30 The Government Plan requests MHSS Yes; this also includes future scoping
£250,000 to fund a feasibility for provision of need in this area of
assessment in order to determine a HCS.
long-term solution for housing
Aviemore residents in alternative
accommodation.
31 The money allocated to the hospital MHSS Yes
project in the Government Plan
(£5 million in 2020 and £1.6 million in
2021) is the continuation of funding
requested by the project team to
develop the Outline Business Case.
The funding will be held by Treasury
and Exchequer and drawn down as
required.
32 The total Heads of Expenditure for the MSS Agreed
Customer and Local Services
Department is £90.6 million. In respect
of Ministerial allocations, the Minister
for Social Security receives the second
highest allocation of funding
(£184 million) for her remit out of all
the Council of Ministers.
33 The Customer and Local Services MSS The £2.22 million can be broken down
Department is committed to making, in as follows:
total, £2.2 million worth of efficiencies £1.0 million Dept operating model
in 2020, £1 million of which is planned savings
to come from a spend reduction in the
Target Operating Model and a review £944,000 Reduced benefit payments
of non-staff costs. It has been proposed based on Q3 2019 forecast
that the remaining £1.2 million worth £100,000 Contracts review
of efficiencies will be found through £136,000 Modern efficient workforce
contract management, more efficient and efficient organisational structures
organisational structures and adopting
Modern Workforce principles. £40,000 One Customer Location.
34 The Government Plan proposes to MSS Yes. This proposal ensures that the
reinstate the States Grant to its full Social Security Fund remains
value by 2023, rather than reinstating it financially sustainable and is able to
in full in 2020. support future generations, whilst
allowing the government to invest more
in public services over the next few
years.
35 The States Assembly will be asked to MSS This is correct.
agree amendments to the Social
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S.R.13/2019 Res.
Findings Minister Comments
Security (Jersey) Law 1974 alongside
the Government Plan. If approved, the
Law will introduce a legal requirement
to reinstate the States Grant to its full
value of £93.1 million by 2023.
36 Consideration is being given to MSS Comment from Treasury: No specific
changing the investment strategy of the individual projects have been identified
Social Security (Reserve) Fund to at present, but examples of potential
allow it to invest in local future projects might be a sports
infrastructure. The Panel was told that campus/complex or student
investment in infrastructure could accommodation as part of an enhanced
complement the existing asset classes higher education offering. Local
held in the fund’s portfolio, increase infrastructure is not an area in which
diversification and offer an appropriate the Social Security (Reserve) Fund is
risk adjusted return. The Panel is still currently invested but examples like
unclear, however, as to the type of those provided could produce revenue
local infrastructure that might receive streams which are aligned to the Fund’s
this investment. investment objectives whilst at the
same time supporting much-needed
investment in the Island’s
infrastructure.
37 The Government Plan proposes a 1% MSS This is correct. The 1% increase would
increase to the headline rate of Long- have provided a sustainable and fairer
Term Care contributions and an long-term care scheme for younger
increase in the income cap from people and future generations.
£176,232 to £250,000
38 Due to availability of allowances and MSS This is correct.
reliefs, most people would pay less
than the proposed 2% in contributions
towards the Long-Term Care Fund as a
percentage of their total income.
39 Diffuse mesothelioma is a disease MSS The number of cases will diminish over
associated with historic exposure to time, but a decrease will probably not
asbestos fibre. As a result, it is not start to be seen for another 10 years as
foreseen that there will be an increase the disease has a very long latency
in diagnosis of the condition following period.
the establishment of the compensation
scheme. Rather, it is expected that
there will be a dwindling of cases over
the next few years.
40 The Panel is satisfied that the amount MSS Acknowledged
of money requested for the “diffuse
mesothelioma scheme” in 2020 is
sufficient and the reasons behind the
request agreeable.
41 The £150,000 funding requested for MSS This is correct.
2020 would pay for expert advice to
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S.R.13/2019 Res.
Findings Minister Comments
help identify options, an approach and
actions to improving financial
independence in old age. The funding
allocation for 2021 would be
dependent on the outcome of the work
undertaken the previous year.
42 The Panel supports the request for MSS Acknowledged. Detailed plans will be
additional funds in 2020 to undertake developed during 2020.
research on financial independence in
old age. However, until the outcome of
the investigation is known, and
proposals of a way forward are brought
to the States Assembly, we are unable
to confirm whether we are content with
the funding allocation for 2021-2023.
43 The triennial regulations that are MSS Agreed
currently in place for the Food Costs
Bonus expire at the end of 2019. The
business case for this project simply
proposes a further extension of the
Bonus at its current value.
44 The Government Plan is seeking MSS Agreed
£2.5 million of additional funds to in
order to maintain the single-parent
component of income support on a
permanent basis.
45 It has been estimated that 1,204 people MSS Agreed
would be accessing the single-parent
component of income support by the
end of 2020. This figure was used to
determine the amount of additional
investment required.
46 Additional funds of £150,000 have MSS Agreed
been requested in 2020 under the
“Support for Home Care and Carers’
project to deliver a pilot scheme,
which will provide additional financial
support to a small number of lower
income families. The scheme will be
aimed at domiciliary care - care
provided in a household by family
members - and it is intended that the
money will assist with extra domestic
costs.
47 The funds will cover a range of MSS Agreed
domestic costs associated with caring
for a family member in the home, it
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S.R.13/2019 Res.
Findings Minister Comments
will not represent a payment to the
carer or a specific amount for every
claimant.
48 Experience gained in 2020 from the MSS Agreed
pilot scheme will be used to inform a
wider scheme available from 2021,
hence the substantial increase in
requested funding for the subsequent
3 years.
49 Whilst the Panel is content with the MSS Acknowledged; detailed plans will be
proposals and satisfied with rational developed during 2020.
behind the request for additional funds,
at this stage we are unable to conclude
whether the resource allocation for the
years 2021-2023 is appropriate until
we understand the outcome of the pilot
scheme.
50 The additional funding requested in the MSS Attached at Appendix 1 is a provisional
Government Plan for the “Disability list of actions prioritised for the
and Community Strategy” project will Disability Strategy in 2020; this
support the roll out of a wide range of includes permanent staffing resource.
projects from 2020 onwards. However, The 2020 projects are in the process of
at the time of producing the being discussed by the Disability
Government Plan, the identification of Strategy Delivery Group (DSDG). The
these projects was still under DSDG is a collaboration between
discussion. The Disability Strategy Government officers, voluntary and
Delivery Group was due to consider a community organisations and
draft list at its meeting in October. individual service users. The proposed
projects are a combination of actions
listed as ‘medium-term’ in the Strategy
(which was published in 2017), and
‘new’ actions identified by the group
over the past 2 years.
The recommendations of the DSDG
will be considered by the Minister for
Social Security who has political
oversight of the Disability Strategy.
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S.R.13/2019 Res.RECOMMENDATIONS
Recommendations To Accept/ Comments Target
Reject date of
action/
completion
1 The Minister for Health and MHSS Agree A detailed breakdown is provided in
Social Services should the attached briefing at Appendix 2.
provide a detailed The £9 million of efficiencies are
breakdown of how his broken down across HCS in a
department intends to make number of schemes, these being –
£9 million of efficiencies in
2020, before the debate on 1. Operational Excellence
the Government Plan. • Continuing Care
• Mental Health
• Support Services
• Intermediate Care
• Community & Voluntary
• Off-island acute services
• Productive theatres
• Acute floor
• Outpatient services
2. Commercial and Customer
• Pharmacy and drugs
• Non-pay costs
• Income recovery
• Cross cutting commercial
3. Modern Workforce
• Nursing establishment and
bed reconfiguration
• Medical staffing
• Modernisation of services
and skill mix
Target Operating Model
2 The Minister for Health and MHSS Partially This will be possible once the central
Social Services should agree HR system has been reconfigured to
provide the Panel will an the new HCS care group structure. If
updated table every quarter there are any delays to this then there
noting the number of funded will be an impact on the ability to
posts, actual staff in post report to Scrutiny.
and vacant posts within the
hospital.
3 In advance of any changes MTR Response from Treasury: No
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S.R.13/2019 Res.Recommendations To Accept/ Comments Target
Reject date of
action/
completion
being made to the specific individual projects have
investment strategy of the been identified at present. Local
Social Scrutiny (Reserve) infrastructure is not an area in which
Fund, the Minister for the Social Security (Reserve) Fund is
Treasury and Resources currently invested but projects which
should provide the States produce revenue streams aligned to
Assembly with the Fund’s investment objectives
documentation in respect of could be considered. At the same
the proposed changes, time, this would support much-
including details of the local needed investment in the Island’s
infrastructure to be invested infrastructure.
in, any potential risks Under the Public Finances (Jersey)
associated with that Law 2019, the Minister for Treasury
investment, and any risks to and Resources is required to publish
the future projections of the Investment Strategies for Funds and
fund and its objectives cannot act in accordance with those
Strategies until they have been
presented to the States.
4 The Minister for Health and MHSS Agree Yes, this can be provided.
Social Services should
provide the Health and
Social Security Panel with
quarterly updates, starting
from January 2020, detailing
successful recruitment of
staff into the mental health
service. The update should
also provide evidence of
improved collaboration with
third and private sector
partners.
5 The Minister for Health and MHSS The Government Plan includes a
Social Services should £5 million capital sum in 2020 for
provide clarity ahead of the Health services improvements
Government Plan debate as (including IT development). This is
to how the digital and health planned to be split between the
care strategy, and digital and the estates infrastructure
specifically the digital programmes. Thereafter, the strategy
patient records system, is to implementation will continue to be
be funded. implemented each year, financed
from both capital and revenue, with
the funding source being aligned
with each project and developed and
refined over the Government Plan
period.
6 The Minister for Health MHSS Partially Response from Minister for Social
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S.R.13/2019 Res.Recommendations To Accept/ Comments Target
Reject date of
action/
completion
Social Services should agree Security: A provisional list of
provide the States Assembly actions prioritised for the Disability
with a list of projects that Strategy in 2020 is provided in
will receive funding under parallel. These 2020 projects are in
the overarching “Disability the process of being discussed by the
Community Strategy” Disability Strategy Delivery Group
project ahead of the debate (DSDG). The DSDG is a
of the Government Plan. collaboration between government
officers, voluntary and community
organisations and individual service
users. The proposed projects are a
combination of actions listed as
‘medium-term’ in the Strategy
(which was published in 2017), and
‘new’ actions identified by the group
over the past 2 years.
Their recommendations will then be
considered by the Minister for Social
Security who has political oversight
of the Disability Strategy.
7 The Minister for Health and MHSS Agree The work to Clinique Pinel is a HCS
Social Services must priority and is regularly monitored.
continue to put pressure on
those delivering and
undertaking the work to
Clinique Pinel to ensure that
it is completed, and the
place of safety is in place,
by the end of 2020.
8 The Minister for Health and MHSS Agree As above
Social Services should
provide the Health and
Social Security Panel will
quarterly updates, starting
from January 2020, detailing
the timetable for the
completion of work and
highlighting any delays and
the contributing reasons.
9 The Minister for Health and MHSS The split between maintenance work
Social Services should and the patient record is £4.1 million
provide clarity to the States maintenance and £0.9 million on
Assembly before the debate digital.
of the Government Plan to
as to how the £5 million
requested for 2020 will be
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S.R.13/2019 Res.Recommendations To Accept/ Comments Target
Reject date of
action/
completion
apportioned between
maintenance work to the
current hospital and primary
work on the digital patient
records system.
CONCLUSION
Minister for Health and Social Services:
The Minister expresses his thanks to the Panel and looks forward to working with the
Panel in implementing the recommendations.
Minister for Social Security:
The Social Security Minister welcomes the findings contained in this report.
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S.R.13/2019 Res.APPENDIX 1
Disability Strategy proposed projects for 2020 (as noted by the Disability
Strategy Delivery Group on 11.12.19)
Strategic
Action Narrative
Reference
Staffing resource
Specialist resource within Government of
Jersey (GoJ) to provide expert advice and
Disability officer
guidance and promote disability awareness
in the Island.
Dedicated resource to manage oversight and
Project manager
delivery of strategy actions.
Strategic Policy Performance and
Disability and diversity policy development.
Population policy resource
Dedicated disability officer post within
Disability Sport officer
Jersey Sport (through Jersey Sport funding).
Proposed projects to be delivered within existing budgets or through new
dedicated resource
Policy team to conduct initial scoping
exercise to identify work required to extend
United Nations Convention Rights
United Kingdom ratification of the
Persons Disability scoping work
convention, including establishing an
independent monitoring body.
Review GoJ customer service policies to
ensure they are equitable and that
Customer service policies review and
1.2b accessibility requirements of disabled
develop communication policy
customers are met. Develop clear policy on
communication with disabled customers.
Communication support needs in Explore options for an Accessible
1.3a
healthcare settings Information Standard in Jersey.
Co-ordinate development of offering for
Increase access to health and fitness generic fitness groups – including walking
3.3c
groups groups, armchair yoga etc. to meet needs of
younger and older disabled adults.
Voluntary Community Sector (VCS) Work with VCS umbrella and structural
3.1c offering re under-supported organisations to map current VCS support of
conditions disabled islanders and identify gaps.
Work with trade and promotional bodies to
Meeting communication needs of communicate benefits of meeting disabled
3.3d
customers customer needs, including awareness of
discrimination legislation.
Establish working group to promote
5.1b Working group – disability awareness disability awareness Island-wide, including
work with media outlets.
Proposed projects with additional resource required
Develop Government policy on providing
1.2b Accessible Government information
documents in an accessible format.
Communication training in care Improve communication support in
1.3b
settings community and care settings.
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S.R.13/2019 Res.Introduce community-based post of
volunteer driver co-ordinator to set-up and
2.1c Volunteer driver scheme
manage an island-wide volunteer driver
scheme.
Establish a reference group of disabled
volunteers to advise on accessibility of
2.2c/2.3a Accessibility reference group
buildings. Train group to provide advice and
guidance and support an Island access audit.
Develop the respite and short break services
available to individuals and carers with a
3.2b Develop respite offering
view to increasing the variety and flexibility
of options available.
Ensure that discrimination legislation is
Accessible discrimination provided in accessible formats – including
4.2b
information British Sign Language. Explore options for
advocacy and support.
Co-ordinate an annual event where disabled
5.2a Engagement event Islanders can share their experiences with
elected members.
Commission research to better understand
the extra costs associated with disability and
5.2b The cost of living with a disability work with local businesses, VCS and service
providers to develop positive action to
mitigate against these costs.
Improve social inclusion and support Research and explore opportunities for
diversity supporting diversity within the Island.
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S.R.13/2019 Res.APPENDIX 2
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